Moyal L, Abrieu-Lacaille M, Bonnel S, Sendon D, de Rivoyre B, Berguiga M, Rambaud C, Froussart-Maille F, Rigal-Sastourné J-C
Service d'ophtalmologie, hôpital d'instruction des armées-Percy, 101, avenue Henri-Barbusse, 92141 Clamart cedex, France.
Service d'ophtalmologie, hôpital d'instruction des armées-Percy, 101, avenue Henri-Barbusse, 92141 Clamart cedex, France.
J Fr Ophtalmol. 2015 Apr;38(4):306-15. doi: 10.1016/j.jfo.2014.10.010. Epub 2015 Apr 1.
The management of presbyopic patients is a medical, surgical and economic issue. We wondered which procedure, whether a Presbylasik technique called Regular Supracor or the intraocular surgery of clear lens replacement by a trifocal diffractive lens (presbyopic lens exchange [Prelex]), provided the best results (in visual acuity and satisfaction) for our hyperopic and presbyopic patients between 55 and 70. The aim of this study was to compare the safety and efficacy of the two techniques (at one week and three months) and to assess patients' quality of life.
This study is a retrospective monocentric clinical trial conducted between June 2011 and March 2014, on 21 hyperopic presbyopic patients (mean age 60.9 years), in the "hôpital d'instruction des armées-Percy" (Clamart); 13 patients underwent the corneal treatment of Presbylasik (with the Intralase FS60 femtosecond laser [AMO, USA] and the Technolas 217P excimer laser [Technolas Perfect Vision, GmbH] following the Zyoptix Tissue-Saving algorithm adjusted with a nomogram and the Regular Supracor mode), and 8 patients underwent clear lens extraction (Prelex), through bimanual phacoemulsification and implantation of diffractive trifocal intraocular lenses (Finevision Micro F, PhysIOL(*)).
Mean uncorrected binocular distance and near vision visual acuity in the Supracor group were respectively 0.03 (-0.2-0.1) LogMar and 0.23 (0.06-0.36) one week postoperatively and 0.031 (-0.2-0.1) and 0,166 (0.06-0.36) three months postoperatively. In the Prelex group, the mean uncorrected one week binocular VA was 0.025 (0-0.1) for distance vision and 0.165 (0.06-0.18) for near distance and the three months visual acuity was 0 (-0.1-0.1) and 0.105 (0.06-0.18) for distance and near vision. All Prelex patients were spectacle-free at all distances, whereas 4 Supracor patients required spectacles for near vision postoperatively. Seven of 11 patients in the Supracor group and 100% of the Prelex patients were completely satisfied. Both groups experienced halos, but patients reported more halos in the Prelex group (75%). One eye required intraocular lens exchange and four eyes (16.7%) required a new corneal procedure in the Supracor group.
Both surgeries are safe and effective modalities in the management of hyperopic and presbyopic patients. However, the Prelex procedure seems to be more appropriate for patients over 55 years of age.
老花眼患者的治疗是一个医学、手术和经济问题。我们想知道哪种手术，即一种名为常规Supracor的老视激光原位角膜磨镶术（Presbylasik）技术，还是通过三焦点衍射晶状体进行透明晶状体置换的眼内手术（老视晶状体置换术[Prelex]），能为55至70岁的远视和老花眼患者提供最佳效果（在视力和满意度方面）。本研究的目的是比较这两种技术在术后一周和三个月时的安全性和有效性，并评估患者的生活质量。
本研究是一项回顾性单中心临床试验，于2011年6月至2014年3月在“军队教学医院 - 珀西”（克拉马尔）对21例远视老花眼患者（平均年龄60.9岁）进行；13例患者接受了Presbylasik角膜治疗（使用美国AMO公司的Intralase FS60飞秒激光和德国Technolas Perfect Vision公司的Technolas 217P准分子激光，按照Zyoptix组织保存算法并根据列线图和常规Supracor模式进行调整），8例患者接受了透明晶状体摘除术（Prelex），通过双手微切口超声乳化术并植入衍射三焦点人工晶状体（Finevision Micro F，PhysIOL(*)）。
Supracor组术后一周的平均未矫正双眼远距离和近距离视力分别为0.03（-0.2 - 0.1）LogMar和0.23（0.06 - 0.36），术后三个月为0.031（-0.2 - 0.1）和0.166（0.06 - 0.36）。在Prelex组中，术后一周的平均未矫正双眼远距离视力为0.025（0 - 0.1），近距离视力为0.165（0.06 - 0.18），术后三个月的远距离和近距离视力分别为0（-0.1 - 0.1）和0.105（0.06 - 0.18）。所有Prelex患者在所有距离均无需佩戴眼镜，而4例Supracor患者术后近距离视力需要佩戴眼镜。Supracor组11例患者中有7例和100%的Prelex患者完全满意。两组均出现眩光，但患者报告Prelex组眩光更多（75%）。Supracor组有一只眼睛需要更换人工晶状体，四只眼睛（16.7%）需要进行新的角膜手术。
两种手术在远视和老花眼患者的治疗中都是安全有效的方式。然而，Prelex手术似乎更适合55岁以上的患者。
